Administrative Code

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Virginia Administrative Code
Title 12. Health
Agency 5. Department of Health
Chapter 200. Regulations Governing Eligibility Standards and Charges for Medical Care Services to Individuals

12VAC5-200-270. Rights.

A. If an applicant for or recipient of medical care services as defined in these regulations is denied such services, has services terminated, wishes to contest the determined income level, or is denied a waiver as defined in Part VI of these regulations, the applicant/recipient is entitled to appeal that action as set forth under this part. There are no further rights of appeal except as set forth in this part.

B. The applicant/recipient has the right to be informed in writing of the appeal process, including time limits, and the right to receive a written statement of the reasons for denial. If a person already receiving services is denied those services, a written notice of termination shall be given 30 days in advance of discontinuing services. The person has the right to confront any witnesses who may have testified against him.

C. An individual or his representative may make a written or oral appeal to the district or program director within 30 days of the denial of service.

D. Upon receipt of the appeal, the district director shall review and make written recommendations to the commissioner, or commissioner's designee, within 15 days. Within 45 days following the date on which an appeal is filed, the commissioner, or commissioner's designee, shall make a final decision.

E. Services to applicants/recipients shall continue during the appeal process.

Statutory Authority

§§ 32.1-11 and 32.1-12 of the Code of Virginia.

Historical Notes

Derived from VR355-39-100 § 7.1, eff. December 1, 1993; amended, Virginia Register Volume 20, Issue 22, eff. August 11, 2004.

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